• 1. Case Coordinator : Assures that employees are aware of changes in appointments for injured workers. Maintains accurate records of appointment history in tracking software
• 1.1 1a. Receives information form Occupational Health and Physical Therapy regarding no shows, cancellations, and reschedules. 1b. Obtains reports of diagnostic studies completed by outside vendors and schedules referral follow up appointments with clinician. 1c. Contacts specialist's office or Physical Therapy office, to secure appointments and documents in Systoc. 1d. Follows protocol to insure that the patient is notified of the appointment, confirms appointments with employer also. 1e. Provides patient with directions and instructions for appointment. 1f. Supplies the referral source with insurance info (identity of adjustor and case mangers with phone/fax numbers), claim number, medicals, MRI and xray reports, codes chart. 1g. When scheduling IE P.T. appointments, uses coding system to label appointment access which will contribute to statistical information reflecting on P.T. access and scheduling changes.
• 2. Accountable for obtaining authorization and precertification from insurances for continued referral and treatment of patients.
• 2.1 2a. Establishes contact with insurances. Identifies patient needs. Logs entry into Systoc. 2b. If authorization/precertification not obtained on initial call, recontacts adjuster in 24-48 hours. 2c. Will notify department designee of updates/change in client company demographics to be reflected in system/flow sheet. 2d. Schedules patient appointments after authorization/precertification obtained as required and forward appropriate documents to referralsource. 2e. Tracks all outstanding calls for Pre-certifications. 2f. Uses the Systoc system to monitor status of authorization for treatment process. 2g. Keeps clinical staff apprised of progress of cases being referred out. 2h. Documents all correspondence in Systoc (insurance representative, phone calls, faxing medicals).
• 3. Reviews cases using established criteria to determine cases that may require additional intervention.
• 3.1 3a. Identify cases requiring further clinical investigation. 3b. Inform Injury Tracking Coordinator II of progress of case to the point of requiring clinical investigation. 3c. Turn case over to Injury Tracking Coordinator II when appropriate; completing all documents. 3d. Follows departmental protocol, which is driven by Worker's Compensation Regulations for appropriate responses of MCO, TPA and employer, and appropriately notifies supervisor and clinicians when unable to obtain certification in a reasonable timeframe.
• 4. Coordination/Customer Service. Formulates and uses effective working relationships with all health care team members, patients, and significant others in order to allow for appropriate coordination of patient care activities.
• 4.1 4a. Formulates and uses effective working relationships with all health care team members, patients and significant others. 4b. Uses a customer service approach to identifying and responding to concerns expressed. 4c. Demonstrates the necessary interpersonal skills and commitment to team building and customer service. 4d. Is responsible for identifying client company and patient questions or concerns; takes responsibility for identifying resource person(s) to address concerns. Assures that identified person has accepted responsibility for addressing that concern. 4e. Consistently demonstrates efficient utilization of hospital resources, and is familiar with department contingency plan and procedure. 4f. Appropriately prioritizes activities, adjusts workload, and coordinates tasks in order to be as efficient and productive as possible. 4g. Adheres to hospital and department standards of confidentiality and HIPAA compliance. Maintains confidentiality by communicating patient and employee information in an appropriate manner only to health care workers involved in the care of the employee and/or patient. 4h. Upholds patient's rights as identified within the institution. Is aware and sensitive to the patient's Bill of Rights of the hospital and the ANA Code of Ethics. Adheres to the mission of the hospital and the Ethical and Religious Directives Health facilities and related hospital policies
• 5. Monitors and coordinates open cases and is responsible for running reports, reviewing outstanding days open, and closing cases as appropriate.
• 6. Will complete other duties/tasks as needed within the department and within scope of practice.
• 6.1 6a. Documentation: Performs complete documentation responsibilities associated with patient care activities and communication. 6b. Responds to all request for medical records from attorneys, insurers and social security disability claims following hospital guidelines for release of medical information. 6c. Records on excel spread sheet a record of request and when mailed out or who (office/department) records were forwarded to for completion 6d. Completes data entry in Systoc patient medical record of documents released and/or scanned into patient record. 6e. Notifies department designee of updates/changes in client company demographics to be reflective in system/company profile. 6f. Covers exit function as needed. 6g. Accounts for and completes grant sheets on initial injuries. 6h.Completes fields in "injury screen" and "state form" required to complete OSHA Log on all cases of injury.

EDUCATION

High school graduate GED required. **Employees employed by YNHH effective 9/12/2012 as a result of the acquisition of the Hospital of St Raphael may meet educational requirements with the applicable combination of education and experience and demonstration of current competences.

EXPERIENCE

1-3 years of healthcare experience, preferrably in Occupational Health and 3-5 years computer experience

LICENSURE

Medical Assistant Certification preferred.

SPECIAL SKILLS

Knowledge of medical terminology. Good organizational skills and ability to prioritize work; very good written and communication skills are essential in meeting customer service requirements, phone skills essential. Medical Assistant Certification preferred.

PHYSICAL DEMAND

sedentary work.